Surgery for obstructive sleep apnea: Sleep endoscopy determinants of outcome
Surgery for obstructive sleep apnea: Sleep endoscopy determinants of outcome
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DOI：
10.1002/lary.23462
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发表时间：
2012-11-01
期刊：
影响因子：
2.6
通讯作者：
de Vries, Nico
中科院分区：
文献类型：
--
作者：
Koutsourelakis, Ioannis;Safiruddin, Faiza;de Vries, Nico
目的/假设：虽然药物诱导睡眠内镜常用于阻塞性睡眠呼吸暂停（OSA）患者接受上呼吸道手术时确定梗阻部位，但其结果是否与手术结果相关尚不清楚。本研究验证了药物诱导睡眠内窥镜变量可以预测OSA患者上呼吸道手术结果的假设。研究设计：病例系列回顾性分析。方法：49例OSA患者（41例男性，平均呼吸暂停低通气指数[AHI] 30.9 +/- 18.5事件/小时）接受异丙酚诱导睡眠内窥镜检查，随后进行上呼吸道手术（腭部手术，和/或舌基射频消融，和/或舌骨悬吊），随后随访多导睡眠图评估手术结果。结果：有应答者23例（47%），无应答者29例（53%）。与应答者相比，无应答者在舌底或会厌完全或部分圆周塌陷、完全前后塌陷的发生率更高。多因素logistic回归分析显示，在基线临床和多导睡眠图特征（如AHI、体重指数）和睡眠内窥镜检查结果中，膜片完全周向塌陷和舌根完全前后塌陷是上呼吸道手术失败的唯一独立预测因素。结论：药物诱导睡眠内窥镜可用于预测OSA患者对上呼吸道手术反应的可能性。喉镜,2012
Objectives/Hypothesis: Although drug-induced sleep endoscopy is often employed to determine the site of obstruction in patients with obstructive sleep apnea (OSA) who will undergo upper airway surgery, it remains unknown whether its findings are associated with surgical outcome. This study tested the hypothesis that drug-induced sleep endoscopy variables can predict the outcome of upper airway surgery in OSA patients. Study Design: Case series retrospective analysis. Methods: Forty-nine OSA patients (41 male; mean apnea-hypopnea index [AHI] 30.9 +/- 18.5 events/hour) underwent propofol-induced sleep endoscopy followed by upper airway surgery (palatal surgery, and/or radiofrequency ablation of the tongue base, and/or hyoid suspension) and subsequently a follow-up polysomnography to assess surgical outcome. Results: Twenty-three patients (47%) were responders, and twenty-nine were nonresponders (53%). Nonresponders had a higher occurrence of complete or partial circumferential collapse at velum and complete antero-posterior collapse at tongue base or epiglottis in comparison with responders. Multivariate logistic regression analysis revealed that among baseline clinical and polysomnographic characteristics (e.g., AHI, body mass index) and sleep endoscopy findings, the presence of complete circumferential collapse at velum, and of complete antero-posterior collapse at tongue base were the only independent predictors of upper airway surgery failure. Conclusions: Drug-induced sleep endoscopy can be used to predict higher likelihood of response to upper airway surgery in OSA. Laryngoscope, 2012